Provider Demographics
NPI:1942797477
Name:WILLIAMS, JOHN MATTHEW
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 E ARBOR AVE
Mailing Address - Street 2:BUILDING 2, SUITE 108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:BUILDING 2, SUITE 108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-219-1010
Practice Address - Fax:480-219-1771
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161175208800000X
AZ72674208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117751400Medicaid
FL2GS0NOtherBCBS